More than one fifth of the world’s population consists of women of reproductive age. On average, a woman spends seven years of her life menstruating, making menstruation a natural and essential part of the reproductive cycle. In addition to menstruation, women also experience other forms of vaginal bleeding and at the end of the reproductive cycle they experience menopause. It is an essential human right to have the ability to manage menstrual health and all other forms of vaginal bleeding with adequate knowledge, safety, and dignity and without stigma. Menstruation is a highly relevant theme in Bangladesh as it plays a role in the interplay between health, hygiene and development issues.
Though MH has recently gained attention in the global development agenda, it is still a taboo topic in many countries, including Bangladesh, where cultural beliefs and social norms restrict the participation of women and girls in society during menstruation. Furthermore, women and girls lack access to the information, products and infrastructure that is needed to manage menstruation with dignity. This has a severe impact on their health, well-being, and the realisation of their rights. It should be noted that adolescent girls, and girls and women living with a disability, are especially vulnerable to negative outcomes related to menstruation, including effects on their overall self-esteem and confidence.
Bangladesh is currently experiencing rapid economic growth and industrialisation. As well as the rest of the country, this also has a positive impact on the situation of Bangladeshi women and girls, as shown by more girls enrolling in junior secondary school, girls and women’s improved academic performance, and more young women participating in (formal) employment.
At the same time, Bangladesh remains a country with deep-rooted cultural traditions that determine gender roles and form the basis of gender discrimination against girls and women. Many Bangladeshi girls and women face malnutrition and gender based violence, while child maternal mortality rates are high. The Ritu programme is positioned within this contrast of steady economic growth and regressive social and cultural barriers that prevent girls and women from exercising their basic rights.
The Ritu programme
Ritu is a girls ’name and means ‘season’ in Bengali and is also used to indicate menstruation in Bangladesh. A suitable name for a programme that aims to promote improved Menstrual Health (MH) among school-going girls in Bangladesh.
Read the study protocol here.
• Improved health and well-being of girls between 10 and 13 years in Netrakona, Bangladesh.
• Improve menstrual hygiene and related well-being of girls between 10 and 13 years in Netrakona, Bangladesh.
• Increased knowledge and improved attitudes and practice on menstrual hygiene of girls, boys, men and women.
• Increased commitment towards menstrual hygiene management by the government and civil society in Bangladesh.
• Women and girls have access to better MHM facilities at schools and affordable (biodegradable) sanitary napkins.
Together with RedOrange -a Bangladeshi media and communication agency-, knowledge institute TNO, and with support of the Embassy of the Kingdom of the Netherlands (EKN), Simavi implements the Ritu programme to promote menstrual health in Bangladesh. Our main goal is to structurally improve the health, wellbeing, and social and economic participation of girls between 10 and 13 years old.
The Ritu Programme consists of three main elements: 1) the interventions in Netrakona that are directly targeted at school girls, 2) a national communication and advocacy campaign, and 3) the development of a biodegradable sanitary pad.
The programme started with a six month inception phase, that provided us with the opportunity to consult existing rigorous evidence on menstrual health programming in Bangladesh and on a global level. Based on this information, gaps were identified and used to design our formative research. Based on the information gathered, the final mix was further defined in a series of workshops with the partners and with the support of the Impact Centre Erasmus University (more information on Evidence Informed Programming can be found here).
- Empower girls, women, men and boys (communities) to have a better understanding of MHM and engage in healthy behaviour, including accessing safe and quality MHM services.
In Netrokona, Bangladesh, Simavi combines WASH and SRHR interventions in schools and communities to improve overall well-being of girls during their menstrual health as part Ritu programme. Simavi works with two local partners: BNPS, that implements the training of teachers and parents on menstrual health and DORP, that realizes gender sensitive toilets through a resource mobilisation method.
The programme in Netrakona consists of an evidence informed mix of interventions that is carefully sequenced. Based on the idea that toilets need to be in place in order for girls to practice their newly learned behaviour, our interventions in schools are sequenced as follows: 1) kick-off in schools to inform teachers and students about the programme, 2) budget tapping process with students and School Management Committee to realize toilets, 3) training of head master and 10 teachers and parents of the school girls.
To ensure a conducive menstrual health environment in schools, BNPS trains an average of 10 teachers per school, in addition to the headmaster. The comprehensive manual that is used for the training of both teachers and parents is rights-based, is based on WASH and SRHR information and combines key information with interactive exercises. Topics range from the reproductive cycle, gender, the role of men, influence of contraceptive use on menstruation, to negotiation skills, good practices to maintain hygiene, guidelines for girl friendly toilets and nutrition. As part of the training, BNPS works with teachers to integrate the different sections of the manual in the existing lesson plan in correspondence with the national curriculum. The quality and progress of the training of teachers and the implementation of the new knowledge and skills in the class room is carefully monitored by the partners and Simavi’s Ritu team. Support systems and refresher trainings are designed based on the progress of teachers and the overall school environment against the set indicators.
To ensure that in addition to the school environment, girls are supported to improve their menstrual health at home, BNPS trains the parents of the girls following the same manual as is used to train the teachers. The sessions are supported with printed information and education materials that RedOrange developed together with Simavi.
- Build an enabling environment in which government and civil society actors show more commitment towards MHM.
As part of their communication strategy, our partner RedOrange developed and implemented a range of edutainment materials and events that aim to influence the national discourse on menstrual health. This includes the Ritu website and Facebook Page. RedOrange also produced a successful TV Series called The Best School for Girls. Together with Simavi, RedOrange also organised the launch of the Ritu programme and the yearly celebration of MHM Day.
- RituOnline: http://rituonline.org/
- Facebook: (https://www.facebook.com/RituKothon)
and “Best school for girls’’ (https://www.facebook.com/MeyederSheraSchool)
As part of the Simavi programme, Simavi brought together a range of different stakeholders from SRHR, WASH, Education, Government and the Private Sector, working on menstrual health in Bangladesh. Together, these stakeholders formed the MHM Platform that is chaired by our partner BNPS. The members of the platform jointly advocate for integration of menstrual health in the Teacher Training and Secondary School curricula as well as for the implementation of gender sensitive WASH in schools.
Simavi has also trained local NGOs on menstrual health to strengthen their capacity following our MH manual.
- Ensure that affordable and sustainable MHM services are in place and utilised.
Our local WASH partner DORP works closely with School Management Committees and groups of parents in communities to realise gender sensitive toilets. To realize these toilets, DORP implements a social accountability approach named budget tapping. This approach builds on a joint budget tapping exercise where DORP mapped budget available for sanitation in schools at different government levels in Bangladesh. This exercise identified a discrepancy between budget allocated by the national government and the actual expenditure on district an union level. Through the budget tapping approach, DORP works with schools to allocate money for MHM friendly toilets from school and where needed to access available government budget. School Management Committees and students are empowered to use social accountability methods to voice their demands to Union or District level government representatives. At the same time, DORP raises awareness of local government representatives on the importance of MHM friendly toilets and supports the budget allocation process.
As partner in the Ritu project TNO took the necessary actions to ensure that biodegradable sanitary napkins will become available in Bangladesh. The collaboration of TNO and the Dutch company Rodenburg Biopolymers since 2016 resulted in coming to a successful recipe for the industrial production of biodegradable thin foil at an affordable price. This foil is made of an innovative blend of potato starch and clay and can be used as water resistant ant-leakage layer in sanitary pads. Based on this business case analysis it is shown that biodegradable sanitary napkins can be sold for 0,05 US dollar per napkin which is equal to the current lowest price for which basic napkins are available in Bangladesh at the moment. TNO is working with a Bangladeshi sanitary pad producer to produce biodegradable sanitary pads using the foil.
Ensuring programme quality
Simavi works closely with Impact Centre Erasmus University to ensure programme quality. For example, the different trainings that are part of the programme have all been piloted to ensure that these resulted in the wanted change in knowledge and skills. Furthermore, the quality and progress of the training of teachers and the implementation of the new knowledge and skills in the class room is carefully monitored by the partners and Simavi’s Ritu team. This means that Simavi also monitors the capacity of staff that implement the trainings. Support systems and refresher trainings are designed based on the progress of teachers and the overall school environment against the set indicators.
Randomized Controlled Trial
In addition to in-depth monitoring of quality and progress, the programme is evaluated through a Randomized Controlled Trial (RCT) in close collaboration with the Maastricht University and Johns Hopkins University. With this RCT we aim to contribute to the current evidence base of MH programs by conducting the first large scale RCT study on the impact of a MH program. We aim to i) compare the school attainment and psychosocial wellbeing of girls across our control and treatment groups, ii) analyze the exact costs per treatment and its cost-effectiveness and iii) explore how the school-level and household-level intervention components affect the lives of girls and iv) analyze the change in perceptions of MHM among pupils, teaching staff and parents.
Read the study protocol here.
This programme is still running up to March 2020. A thorough needs assessment , a baseline as well as a programme evaluation have been conducted. The final programme report including the RCT findings follow after the end of the programme.